choledocholethiasis details Flashcards
ascending cholAngitis/
tx
- begin immediately :
Blood cultures; IV broad-spectrum Abx +
IV hydration
- Biliary drainage with ERCP : performed urgently in pts w moderate to severe disease/or in pt w
persistent pain;
hypotension;
altered mental status;
persistent high fever;
WBC 20;000/mcL; and bilirubin =+10 mg/dL
pt w gall stone/
% w stone in the CBD=choledocholithiasis
20%
choledocholithiasis/tx
choledocholithiasis w/out ascending cholangitis;
CBD stones removed via intraoperative CBD exploration or ERCP.
Or choleCystEctomy
pancreatitis + elevated ???
Suggests pancreatitis secondary to gallstones (GAP)_
pancreatitis= HIGH serum lipase (=> etiology= Gall stone) /
High ALT or AST> 100 IU/L=> GAP
BUT AST <50 IU/L=>GAP UNlikely
pancreatitis/
imaging tests to rule in or rule out
rule in:
in ALL pts w pancreatitis/
Transabdominal US to id etiology of gallstones or CBD dilatation => GAP.
rule out:
Plain radiography =>no free air or SBO.
NOT CT: id pancreatitis (u can c the inflammation but not the stone) == NOT the etiology
pancreatitis/
imaging/CBD dilatation suggesting.
GAP
acute pancreatitis
/tx
monitoring:
in: IV fluid : to <->good BP +UO
out: +UO=UOutput
effect of in/out:VS; orthostatic BPs;
carefully monitored to assess intravascular volume.
blood/fx of pancreas: O2; electrolyte; +glucose
No oral intake
Opioids for pain relief
sx controlled: Nasogastric tube if :recurrent vomiting
ICU admission x severe pancreatitis/
Jejunal feeding;
on d/c:Alcohol abstinence
acute pancreatitis/ surgical tx
CholeCystEctomy +
ERCP/sphincterotomy
